Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on patient management: First year's experience in a clinical center

Purpose: To measure the impact of whole-body fluorodeoxyglucose (FDG) posit ron emission tomography (PET) on patient management during its first year o f use in a community hospital. Materials and Methods: First-year FDG-PET impact was determined from 463 re ferring physicians' evaluations of their patients' PET imaging results usin g two surveys. Survey 1 was given to all physicians referring patients to P ET to discover whether PET changed patient management or had decision-makin g value in the patient's clinical algorithm. Survey 2 was given to one surg eon and one pulmonologist after therapy to determine how PET affected the s urgical, chemotherapeutic, and/or radiotherapeutic treatment for the 53 can cer patients they referred. Results: The 463 responses to survey 1 described 23 different PET indicatio ns. Lung (40%), head and neck (18%), and colorectal cancers (11%) were the three leading causes of referral, PET changed patient management/therapy in 45% of all patients referred and had inferential/decision-making value in another 44%. Overall, PET had some type of positive influence in 412 (89%) of the patients. Survey 2 provided a more detailed assessment of 53 referra ls from two specialists, PET positively affected surgery in 31 patients (58 %), prompted the addition of chemotherapy or radiation therapy in nine pati ents (17%), and eliminated chemotherapy or radiation therapy in four cases (8%). Overall, PET affected patient management/therapy in 70% of the cases and had some decision-making value in another 25%, for a combined PET impac t on patient management of 96%. Conclusion: FDG-PET can be valuable for physicians in clinical practice. It s sensitivity and specificity in metabolic imaging, when combined with comp lementary anatomic imaging techniques, contribute significantly to the clin ical treatment of cancer patients. In addition, the high accuracy of FDG-PE T makes it a cost-effective radiologic procedure in the work-up of all susp ected and/or recurrent cancer patients. Further research is needed to link this demonstrated impact on patient management to cost-effectiveness. J Cli n Oncol 19:2504-2508. (C) 2001 by American Society of Clinical Oncology.